|Year : 2021 | Volume
| Issue : 1 | Page : 12-17
Effect of yogic intervention on quality of life in university girls with cyclical mastalgia
Garima Jaiswal, Ghanshyam Singh Thakur
Department of Naturopathy and Yoga, HNB Garhwal Central University, Srinagar, Uttarakhand, India
|Date of Submission||17-Feb-2021|
|Date of Acceptance||06-Apr-2021|
|Date of Web Publication||21-Jul-2021|
Ghanshyam Singh Thakur
Department of Naturopathy and Yoga, HNB Garhwal Central University, Srinagar, Uttarakhand
Source of Support: None, Conflict of Interest: None
Background: Cyclical mastalgia is a benign breast disease and common phenomena in the reproductive age of women. It is the pain in the breast mainly felt in previous 5–7 days of the mensuration cycle. This affects the overall quality of life (QOL) and is linked to fear, fatigue, and other psychological causes. Fear of breast cancer influences the state of mind and badly affect emotional health and entire physical health. The present study was conducted to determine the effect of yogic practice on QOL in girls with cyclical mastalgia.
Methods: Forty females having cyclical mastalgia (last 6 months) were recruited for the study and randomly assigned into two groups (yoga group and control group) with the age range of 20 to 30 years (23.52 ± 2.28). The subjects of both the groups were assessed for quality of life at the baseline and after completion of experimental period of sixty days.
Results: After completing 60 days yogic intervention, yoga group showed significant improvement after 2 months of yoga practices and even after the 1-month follow-up in physical health (<0.01), sociological health (<0.05), environmental health (<0.05), and overall QOL (<0.05) than the control group. Psychological health showed the significant effect after 1 month of follow-up (>0.05).
Conclusion: The results of present study concludes that the quality of life of university girls suffering from cyclical mastalgia can be improved after yoga practices.
Keywords: Yoga, quality of life, cyclical mastalgia
|How to cite this article:|
Jaiswal G, Thakur GS. Effect of yogic intervention on quality of life in university girls with cyclical mastalgia. Yoga Mimamsa 2021;53:12-7
|How to cite this URL:|
Jaiswal G, Thakur GS. Effect of yogic intervention on quality of life in university girls with cyclical mastalgia. Yoga Mimamsa [serial online] 2021 [cited 2022 Dec 1];53:12-7. Available from: https://www.ym-kdham.in/text.asp?2021/53/1/12/322049
| Introduction|| |
The word “breast pain” is frequently used to describe pain discomfort in one or both breasts, and it ranges from moderate pain to agonising pain (Smith, Pruthi, & Fitzpatrick, 2004). The term “Breast Pain” was used by Cooper, in 1829. After that different terminologies were used for describing breast pain such as mastalgia, mastodynia, and fibrocystic-breast-disease or syndrome. A typical condition with an occurrence of 41%–79% is mastalgia or breast pain (Scurr, Hedger, Morris, & Brown, 2014). It can be divided into three categories: cyclical, extra-mammary, and noncyclical (Arce-Salinas, Ramirez-Morales, Alvarado-Miranda, & Lara-Medina, 2014; Gumm, Cunnick, & Mokbel, 2004). While the etiology of mastalgia is not notable, cyclical breast pain is interrelated with the menstrual cycle, with an onset during the late luteal period and menstrual phase termination or decline and is triggered by natural hormonal changes that activate ductal elements (estrogen), stroma (progesterone) or ductal secretion (prolactin), and many more psychological factors (Dogliotti, Orlandi, & Angeli, 1989). Pain in the breast is mainly felt in previous 5–7 days of mensuration cycle. An earlier study showed that pain interferes with all-health domain of life (Niv & Kreitler, 2001). Previous study shows the prevalence of high-risk factors, i.e., anxiety, stress, depression, caffeine, and smoking leading to mastalgia in women and disturbs the quality of life (QOL) (Kanat et al., 2016). QOL differ by gender and type of pain condition; there could be high chances of prevalence of pain and poor QOL in female suffering from cyclical mastalgia (Azizabadi Farahani & Assari, 2010). Several earlier studies have reported that various modern treatments such as Danazol and Bromocriptine improved QOL and pain but the patient experienced complaints about menstrual irregularities, weight gain, headache, and nausea (Durning & Sellwood, 1982; Kontostolis, Stefanidis, Navrozoglou, & Lolis, 1997; Kumar et al., 2010; Mansel & Dogliotti, 1990; Nappi, Affinito, Di Carlo, Esposito, & Montemagno, 1992; Oksa, Luukkaala, & Mäenpää, 2006). Many studies in relation to yoga and pain management have shown promising results. However, there are no such studies which claim the similar effects in mastalgia. The frequency of the pain in mastalgia disturbs the QOL and it affects the day-to-day activities. Therefore, the main objective of present study was to see the impact of yoga practices on QOL in girls suffering from cyclical mastalgia.
| Materials and Methods|| |
Forty girls with age range between 20 and 30 years (23.52 ± 2.82) consented to participate in this study. The subjects were selected from girls' hostel of H.N.B.G University, Uttarakhand. These forty girls were having the symptoms of mastalgia according to Cardiff breast torment graph. Participants who were engaged, pregnant, taking prophylactic pills were excluded from the study. Participants were randomly divided into experiment group (n=20) and control group (n=20) by using online random sequence generator. The study was approved by the Institutional Ethical Committee (Ref. No./2019/04), and written informed consent was also taken from the participants and superintendent of the girl's hostel.
The present study followed a randomized controlled design. Forty participants were divided into two groups: experimental and control groups; each group comprised of twenty participants. The preassessment was done on the date of menstruation, so all participants' QOL was assessed individually. Post data were taken after 60 days of intervention and follow up data was collected after one month. Data were taken three times, i.e., pre, post and follow-up. Yoga module was prepared by specialists and comprised of Asanas, Pranayama, Meditation, and Kriya (cleansing practice) [Table 1]. The experimental group participated in yoga protocol for 90 min. everyday for sixty days. Whereas control group participants continued with their daily schedule and not allowed to participate in yoga training.
Quality of life
Psychological imbalances reflect by QOL and its result from augmented responses to incorrectly perceived environmental situations. QOL was developed by WHO as “Quality of life BREF” (WHOQOL-BREF), it is a valuable instrument to evaluate the progressions over the period of treatment of an individual (The World Health Organization QOL (WHO-QoL-BREF, 2004). This tool has recently been standardized for the use in an Indian population prior and has demonstrated interior reliability (Cronbach's α = 0.87), content validity (0.50–0.77), and predictive validity (0.44–0.63) (Agnihotri, Awasthi, Chandra, Singh, & Thakur, 2010; Meena et al., 2015). WHOQOL-BREF comprises 26 items with five domains. The questionnaire was having five options and subjects were asked to give one response best suited i.e., (1) not at all, (2) a little, (3) moderately, (4) very much, and (5) extremely. Among these 26 items, question 1 surveyed forecast about the general impression of QOL, question 2 was utilized to evaluate the general view of well-being, and the remaining 24 items evaluated four domain of QOL i.e. physical health, social health, and environmental health.
Statistical analysis was done using Statistical Package for the Social Sciences software version 20.0 (SPSS-20.0) (IBM Corporation., Armonk, N.Y., USA). Shapiro–Wilk test was used to test the normality. Shapiro-Wilk test revealed that the data was not normally distributed, hence, Man-Whitney test was used to compare the difference between two groups. Within group comparison (baseline, post test & follow-up) was done by Friedman test followd by post hoc Bonferroni adjustment. Wilcoxon sign-ranked test was performed to detect the statistical significance of condition as compared to respective baseline (before condition).
| Results|| |
Forty females having cyclical mastalgia were recruited for the study and randomly assigned into two groups (yoga group and control group) with the age range of 20 to 30 years.
Between group comparison is presented in [Table 2]. Mann–Whitney U-test indicate that the physical health score of yoga group (Mdn = 23) did not significantly differ from the control group (Mdn = 21.5), U = 140, p = 0.108, after 2-month. However, after one month follow up there was significant difference in physical health score between yoga and control group. (Mdn = 23.5) was significantly different than the control group (Mdn = 20), U = 118.5, p < 0.026. In psychological health score of yoga group (Mdn = 20) there was no significant difference between yoga and control group after two months. (Mdn = 19), U = 138, p = 0.096. However, significant difference was observed in yoga and control group after one month follow-up. (Mdn = 20) was significantly different than the control group (Mdn = 18), U = 121.5, p = 0.033. Sociological health score of yoga group (Mdn = 10.5) In case of sociological health there was no significant difference in yoga and control group after two months. However, one month follow-up showed significant difference. (Mdn = 9), U = 120.5, p = 0.030, after 2-month scores. Further, again at 1-month follow-up scores in the yoga group (Mdn = 10.5) was significantly different than the control group (Mdn = 9), U = 110.5, p = 0.014 In environmental health significant difference between yoga group (Mdn=28) and control group (Mdn=23) U=108, p=0.012 was observed. Further, after one month follow-up significant difference was seen between yoga (Mdn=28) and control group (Mdn=22.5) U=77, p<0.001.
|Table 2: Mean standard deviation and median score of quality of life in yoga and control group|
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Overall, QOL showed significant changes between group comparison. After 2 months, yoga group (Mdn = 80.5) significantly differed than the control group (Mdn = 72.5), U = 108, p = 0.012, Also after 1 month follow-up score of yoga group (Mdn = 83.50) significantly differed than the control group (Mdn = 69), U = 86.5, p < 0.002.
However, within group comparison, Friedman test showed that there was no significant difference in all the domains of QOL [Table 2]. Post hoc test using a Wilcoxon signed-ranked test with a Bonferroni-adjusted alpha level of 0.017 (0.05/3) showed no statistically significant difference in before, after 2 months and 1-month follow-up in all domains. Yoga intervention showed nonsignificant increase trend in the QOL domains, whereas control group showed a nonsignificant decrease trend in QOL scores.
| Discussion|| |
The result of this randomized control trial of 2 months yoga intervention could improve QOL's domain; physical health, psychological health, social health, and environmental health in girls suffering from mastalgia. In the present research, participants were girls suffering from mastalgia. Previous study shows the prevalence of high-risk factor, i.e., anxiety, stress, depression, caffeine, and smoking associated with mastalgia in women and disturbs QOL (Kanat et al., 2016). The research has demonstrated that severe mastalgia in women's daily lives can be attributed to a rise in fear of breast cancer (Leinster, Whitehouse, & Walsh, 1987), it may lead to a disturbance of the QOL. In a large-scale analysis, cyclic mastalgia has been shown to affect domain of QOL such as sleep status by 10%, 6%, and 13%, physical activity by 36%, and sexual activity by 48% (Ader & Browne, 1997). In this perspective Indian traditional yoga practices were found beneficial in improving QOL in various patients who are dealing with pain (Cramer, Rabsilber, Lauche, Kümmel, & Dobos, 2015; Russell, Daniels, Smoot, & Allen, 2019). It is evident from past randomized controlled trial with six month follow-up that QOL and depression scores improved with yoga among nursing students with mastalgia (Raghunath, Raghuram, Ravi, Ram, & Ram, 2016).
The first domain of QOL is physical health, and it deals with feature such as mobility, fatigue, pain, sleep, and work capacity, etc. The results revealed that after practicing yoga for 2 months physical health of the girls with mastalgia was significantly improved (<0.05) as compared to the control group which shows efficacy of yoga in physical health's domain [Figure 1]. Similar positive effect was observed in psychological health domain [Figure 2] of QOL which deals with issues related to emotions, self-esteem, faith, perception, understanding, and memory. Yoga is defined as “mastery over the changes of the mind” (Patanjali) (Swami Prabhavananda, 2002), which is the goal of the integrated yoga programme. Multiple studies have shown the impact of yoga on the reduction of anxiety, (Tang, Holzel, & Posner, 2015) depression, and stress (Carmody & Baer, 2008) with better mental well-being as shown by improved perceptual skills (Telles, Nagarathna, & Nagendra, 1995). This study also shows the significant improvement (p < 0.05) in social health domain [Table 2] which implies the improvement [Figure 3] in personal relationships, social support, and sexual activity. There seems to be an element of yoga practise related to the culture that can be helpful to one's social and spiritual health. Yoga could be useful for emotionally isolated groups, such as those who are elderly, bereaved, and lonely, as well as those who are having relationship crisis (Kishida, Mogle, & Elavsky, 2019; Ross, Bevans, Friedmann, Williams, & Thomas, 2014). The last domain of QOL is environmental health which also improved (p < 0.05) after the 2 months of yoga practices [Figure 4]. Environmental dimensions are one of the major influences of QOL (Streimikiene, 2015). This study also measured overall QOL [Table 2] and result revealed that yoga can significantly (p < 0.05) improve [Figure 5] Overall QOL after the 2 months of practicing and after the 1-month follow-up (p < 0.05). Mastalgia has been reported as a condition that impacts individual's QOL (Ali, 2017). This study can be useful for girls who are having low QOL during the breast pain (Salgado, Mardini, & Chen, 2005). After practicing of yoga, girls experienced less frequency of breast pain. The limitation of present study is that it included small sample size and shorter duration. In fact, long term studies are needed to substantiate the findings of present study.
|Figure 1: The graphical representation of change in physical health score. Line graph for physical health mean shift from the baseline, intervention at the end of 2 months, and follow-up after 1month between the yoga group (n = 20) and control group (n = 20)|
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|Figure 2: The graphical representation of change in psychological health score. Line graph for psychological health mean shift from the baseline, intervention at the end of 2 months, and follow-up after 1 month|
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|Figure 3: The graphical representation of change in sociological health score. Line graph for sociological health mean shift from the baseline, intervention at the end of 2 months, and follow-up after 1 month|
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|Figure 4: The graphical representation of change in environmental health score. Line graph for environmental health mean shift from the baseline, intervention at the end of 2 months, and follow-up after 1 month|
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|Figure 5: The graphical representation of change in overall QOL score. Line graph for overall QOL mean shift from the baseline, intervention at the end of 2 months, and follow-up after 1 month|
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However, future study on the larger population is required to confirm the beneficial effects of yoga. Since this study was limited to measure the QOL in girls suffering from mastagia, the other related factors of breast pain such as breast pain chart and biochemical factors will be required to clarify the role of yoga in the prevention of breast pain in girls during the menstruation cycle.
| Conclusion|| |
Mastalgia is very common complaint in females. Mastalgia in young women is associated with anxiety and depression which hampers QOL. Yoga intervention has showed significant change in QOL as compared to control group in females suffering from mastalgia.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ader, D. N., & Browne, M. W. (1997). Prevalence and impact of cyclic mastalgia in a United States clinic-based sample. American Journal of Obstetrics and Gynecology
(1), 126-132. doi: 10.1016/S0002-9378(97)70450-2.
Agnihotri, K., Awasthi, S., Chandra, H., Singh, U., & Thakur, S. (2010). Validation of WHO QOL-BREF instrument in Indian adolescents. Indian Journal of Pediatrics
(4), 381-386. doi: 10.1007/s12098-010-0041-1.
Ali, A. (2017). Mastalgia : psychological intervention and its impact on quality research article mastalgia : psychological intervention and its impact on quality of life. International Journal of Current Research, 9(3), 47985-47987.
Arce-Salinas, C., Ramirez-Morales, R., Alvarado-Miranda, A., & Lara-Medina, F. (2014). Mastalgia. In Benign Disease of the Breast: Diagnosis and Treatment
(pp. 167-176). Mexico Nova Science Publishers, Inc. doi: 10.3810/pgm.1997.11.369.
Azizabadi Farahani, M., & Assari, S. (2010). Relationship between pain and quality of life. In Handbook of Disease Burdens and Quality of Life Measures
(pp. 3933-3953). New York: Springer. doi: 10.1007/978-0-387-78665-0_229.
Carmody, J., & Baer, R. A. (2008). Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. Journal of Behavioral Medicine
(1), 23-33. doi: 10.1007/s10865-007-9130-7.
Cooper, A., Fripp, G. D., & Bristol Medical Library Society,. (1829). Illustrations of the diseases of the breast. Medical Heritage Library, London.
Cramer, H., Rabsilber, S., Lauche, R., Kümmel, S., & Dobos, G. (2015). Yoga and meditation for menopausal symptoms in breast cancer survivors - A randomized controlled trial. Cancer
(13), 2175-2184. doi: 10.1002/cncr.29330.
Dogliotti, L., Orlandi, F., & Angeli, A. (1989). The endocrine basis of benign breast disorders. World Journal of Surgery
(6), 674-679. doi: 10.1007/BF01658413.
Durning, P., & Sellwood, R. A. (1982). Bromocriptine in severe cyclical breast pain. British Journal of Surgery
, 69(5), 248–249. doi: 10.1002/bjs.1800690505.
Gumm, R., Cunnick, G. H., & Mokbel, K. (2004). Evidence for the management of mastalgia, 20
(5), 681-684. doi: 10.1185/030079904125003377.
Kanat, B. H., Atmaca, M., Girgin, M., Ilhan, Y. S., Bozdağ, A., & Özkan, Z., … Emir, S. (2016). Effects of mastalgia in young women on quality of life, depression, and anxiety levels. Indian Journal of Surgery
(2), 96-99. doi: 10.1007/s12262-015-1325-5.
Kishida, M., Mogle, J., & Elavsky, S. (2019). The daily influences of yoga on relational outcomes off of the mat. International Journal of Yoga
(2), 103. doi: 10.4103/ijoy.ijoy_46_18.
Kontostolis, E., Stefanidis, K., Navrozoglou, I., & Lolis, D. (1997). Comparison of tamoxifen with danazol for treatment of cyclical mastalgia. Gynecological Endocrinology
(6), 393-397. doi: 10.3109/09513599709152566.
Kumar, S., Rai, R., Das, V., Kumar, S., Dwivedi, V., & Agrawal, G. G. (2010). Visual analogue scale for assessing breast nodularity in non-discrete lumpy breasts: The Lucknow - Cardiff breast nodularity scale. Breast
(3), 238-242. doi: 10.1016/j.breast.2010.02.002.
Leinster, S. J., Whitehouse, G. H., & Walsh, P. V. (1987). Cyclical mastalgia: Clinical and mammographic observations in a screened population. British Journal of Surgery
(3), 220-222. doi: 10.1002/bjs.1800740324.
Mansel, R. E., & Dogliotti, L. (1990). European multicentre trial of bromocriptine in cyclical mastalgia. The Lancet
(8683), 190-193. doi: 10.1016/0140-6736(90)90278-D.
Meena, U. K., Sen, R. K., Behera, P., Tripathy, S. K., Aggrawal, S., & Rajoli, S. R. (2015). WHOQOL-BREF Hindi questionnaire: Quality of life assessment in acetabular fracture patients. Indian Journal of Orthopaedics
(3), 323-328. doi: 10.4103/0019-5413.156206.
Nappi, C., Affinito, P., Di Carlo, C., Esposito, G., & Montemagno, U. (1992). Double-blind controlled trial of progesterone vaginal cream treatment for cyclical mastodynia in women with benign breast disease. Journal of Endocrinological Investigation: Official Journal of the Italian Scociety of Endocrinology
(11), 801-806. doi: 10.1007/BF03348808.
Niv, D., & Kreitler, S. (2001). Pain and Quality of Life. Pain Practice
(2), 150-161. doi: 10.1046/j.1533-2500.2001.01016.x.
Oksa, S., Luukkaala, T., & Mäenpää, J. (2006). Toremifene for premenstrual mastalgia: A randomised, placebo-controlled crossover study. BJOG: An International Journal of Obstetrics and Gynaecology
(6), 713-718. doi: 10.1111/j.1471-0528.2006.00943.x.
Raghunath, S., Raghuram, N., Ravi, S., Ram, N., & Ram, A. (2016). Effect of yoga therapy on quality of life and depression in premenopausal nursing students with mastalgia: A randomized controlled trial with 6-month follow-up. Journal of Health Research and Reviews
(2), 48. doi: 10.4103/2394-2010.184229.
Ross, A., Bevans, M., Friedmann, E., Williams, L., & Thomas, S. (2014). “I Am a Nice Person When I Do Yoga!!!”: A Qualitative Analysis of How Yoga Affects Relationships. Journal of Holistic Nursing
(2), 67-77. doi: 10.1177/0898010113508466.
Russell, N., Daniels, B., Smoot, B., & Allen, D. D. (2019). Effects of yoga on quality of life and pain in women with chronic pelvic pain: Systematic review and meta-analysis. Journal of Women's Health Physical Therapy
(3), 144-154. doi: 10.1097/JWH.0000000000000135.
Salgado, C. J., Mardini, S., & Chen, H. C. (2005). Mastodynia refractory to medical therapy: Is there a role for mastectomy and breast reconstruction? Plastic and Reconstructive Surgery
(4), 978-983. doi: 10.1097/01.prs.0000178073.63595.a2.
Scurr, J., Hedger, W., Morris, P., & Brown, N. (2014). The prevalence, severity, and impact of breast pain in the general population. The Breast Journal
(5), 508-513. doi: 10.1111/tbj.12305.
Smith, R. L., Pruthi, S., & Fitzpatrick, L. A. (2004). Evaluation and management of breast pain. Mayo Clinic Proceedings
(3), 353-372. doi: 10.4065/79.3.353.
Streimikiene, D. (2015). Environmental indicators for the assessment of quality of life. Intellectual Economics
(1), 67-79. doi: 10.1016/j.intele.2015.10.001.
Tang, Y. Y., Hölzel, B. K., & Posner, M. I. (2015). The neuroscience of mindfulness meditation. Nature reviews. Neuroscience, 16(4), 213–25. https://doi.org/10.1038/nrn3916
Telles, S., Nagarathna, R., & Nagendra, H. R. (1995). Improvement in visual perception following yoga training. - PsycNET. Journal of Indian Psychology,13
(1), 30-32. doi: psycnet.apa.org/record/1996-93336-001.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2]